Fracture and orthopedic operating machine



Jan. M, 1936. H. M. BERGAMINH FRACTURE AND ORTHOPEDIQ OPERATING MACHINE 2 Sheets-Shet 1 Filed March 21, 1955 a; 2%. ATTORNEYS.

Jan. M 19%- H. M. BERGAMINI fi fi FRACTURE AND ORTHOPEDICOPERATING MACHINE Filed March 21, 1955 2 Sheets-Sheet 2 45 I iNVENTOR 47 $o fi? E Y ATTORNEYS.

Patented Jan. 14, 1936 UNITED STATES FRACTURE AND ORTHOPEDIC OPERATING MACHINE Herbert M. Bergamini, New York, N. Y., assignor of one-half to Albert Stephenson, New York,

Application March 21, 1935, Serial No. 12,244

12 Claims.

This invention relates to a fracture and orthopedic operating frame. It is particularly concerned with an apparatus of the above mentioned character which has for its object the support of a patient in a fixed position for reduction and. manipulation of skeletal injuries such as fractures or dislocations.

A feature of the present invention is that it eliminates the necessity of lifting the patient from a stretcher or stretcher cart onto the operating apparatus or an operating table.

It is a further feature of the present invention that the patient is supported from above so that the space below the patient is free of obstructions so that X-ray apparatus for either X-ray pictures or fluoroscopic examination of the injured part may be conveniently used while the patient is in position on the operating apparatus.

It is a further feature of the invention that the apparatus embodying the invention affords accessibility to the patient for the application of plaster casings, molded plaster splints, or plaster casts, for retention of the reduced deformity. The apparatus of the present invention, moreover, permits of the application of exact mechanical traction to displaced or over-riding fractures.

In the drawings forming part of this specification, 7 V

Figure l is a perspective view of an operating frame embodying features of the invention;

Figure 2 is a fragmentary view in sectional elevation;

Figure 3 is a fragmentary sectional view taken upon'the section line 3, 3 of Figure 2 looking in the direction of the arrows.

, Figure 4 is a fragmentary,detail sectional view of a clamp employed in a part of the apparatus; Figure 5 is a sectional, detail view illustrating the mounting of one of the stirrups employed.

The frame is composed of pieces of pipe or tubing connected by ordinary fittings and joints, a'nd'comprises uprights I, cross rails 2, and longitudinal track rails 3, upon which a carriage I is slidingly mounted. The carriage comprises transverse rails 5 having T couplings 6 on their ends which embrace the track rails 3 with capacity for sliding upon such track rails. The carriage also comprises a housing I having a top plate 8 affixed to the rails 5. A perineal bar 9 is supported by the carriage 4 and extends vertically downward therefrom. At the lower end of the perineal bar 9 provision is made of a small sacral rest Ill adapted to be used for infants, and

a larger sacral rest II adapted to be used for adults; The sacral rest II may be slid upward along the perineal bar and engaged in a spring clip I2 mounted on the carriage to be held out ofthe way when the rest It is to be used.

Normally, however, the rest II bears upon the rest It at the lower end of the bar 9.

Provision is made for adjusting the perineal bar vertically to raise or lower the sacral rest, and of means for adjusting the carriage longitudinally of the frame to shift the perineal bar and the sacral rest horizontally.

For adjusting the perineal bar vertically, provision is made of a rack I3 fixed on the bar and a pinion I4 for engaging and driving the rack. The pinion I4 is fast upon a shaft I5 which is journalled in the housing i of the carriage 4. The shaft I5 also has fast upon it a worm wheel I6 which is driven by a worm I'I journalled in brackets I8 which are carried by the housing "I. 1 The worm shaft extends vertically and is provided at its lower exposedend with an operating wheel I9. Rotation of the wheel I 9 turns the worm I1 and serves thereby to drive the perineal bar upward or downward, as desired, through the worm wheel I6 and the pinion I4. The mechanism is automatically locked and retained in any position to which it may be adjusted, since the worm is of too slight pitch to be driven by the worm wheel I6.

Longitudinal adjustment of the carriage is effected through a long screw 20 which is supported by a frame crossbar 2 I. The screw 20 has collars 22 and 23 fixed upon it on opposite sides of the cross bar 2I for restraining the screw against longitudinal movement. The screw is threaded through a bracket 24 fixed on the housing I and. is provided with an operating wheel or handle 25. Rotation of the wheel 25 in one direction serves to propel the carriage 4 with the depending 3 perineal bar and sacral rest away from the operator, and rotation of the wheel in the opposite direction serves to propel the carriage and the depending parts toward the operator.

When a patient is to be operated upon for an 40 injury such as a leg fracture, he is supported on the sacral rest and caused to straddle the perineal bar. The foot of his injured leg is then secured in one of the stirrup members 26 and the injured leg is then stretched, by manipulation of the stirrup to permit the bone to be set. The stirrups are duplicates of one another and a description of one will sufiice for both.

The stirrups are carried upon a cross bar 2? which is supported on brackets 28 mounted on the uprights I, at the end of the frame. The cross bar 21 has rectangular end portions which fit in sleeves of the brackets 28 to restrain the cross bar against rotation. Each bracket 28 comprises a split ring portion 29 for encircling the associated upright I, and the halves of the split ring portion 29 are provided with jaws 30 which are adapted to be drawn together by a screw 3|. The screw BI is passed freely through one of the jaws and threaded into the other.

It is provided 0' with an operating handle 32. The elevation of the bar 21 may be readily adjusted by releasing the clamping jaws of both brackets 28, shifting the bar up or down, and then tightening the clamping jaws of the brackets.

Each stirrup comprises a foot receiving portion 33 which is pivotally connected through a T member 34 with a threaded stem 35. The threaded stem 35 extends freely through a sleeve 36 and is threaded through a nut 31 which abuts the outer end of the sleeve. The nut is provided with a hand wheel 38 which may be turned. A key 58, fast in the sleeve, enters a groove 59 in the rod, and prevents relative rotation of the rod in the sleeve, which might be injurious to a patients limb. Since the nut abuts the sleeve 35 it is held against movement toward the patient, and consequently rotation of the wheel 38 in a clockwise direction as reviewed in Figure 1 is effective to draw the stirrup forcibly away from the sacral rest and the operating bar.

The stirrup-carrying sleeve 36 is mounted in a split ring 39 having clamping jaws 40 extending from the two halves thereof. A screw 4| extends a freely through one of the clamping jaws and is threaded into the other. The screw 4| is provided with an operating handle 42 for increasing or relieving the clamping pressure. When the clamping pressure is relieved the sleeve may be slid freely through the split ring member 39 and clamped in a new adjusted position. Whenthe apparatus is being used to put traction upon an injured patient, however, the sleeve is clamped in fixed position and the traction is exerted through rotation of the hand wheel 38.

The split ring 39 has a body portion provided with a fiat lower face which rests upon an ear 43 of a supporting bracket 44. The split ring 39 also has a downwardly extending threaded stem 45 which passes through the car 43. A sleeve 46 is threaded on to the stem 45. The sleeve 46 is provided with a hand wheel 4'! whereby the sleeve may be turned to clamp the split ring 39 firmly to the ear 43. When the sleeve 46 is backed off the split ring 39 may be rotated about a vertical axis to change the angular disposition of the stirrups relative to the sacral rest. This adjustment may be fixed by again tightening the sleeve to bind the parts in place.

The supporting bracket 44 includes a split ring portion 48 which encircles the bar 21. The two halves of this split ring are provided with jaws 49. A screw 50 is passed freely through one of the jaws and threaded into the other, and is provided with an operating handle 5| whereby the ears may be drawn forcibly together. When the jaws 49 are permitted to move apart the grip upon the bar 21 is relaxed and the entire stirrup structure may be adjusted either laterally of the frame or angularly about the axis of the bar 21. The adjustment may be maintained by again tuning the handle 5| to tighten the grip of the split ring 44 upon the bar 21.

It is generally desirable to support the patients injured leg in a sling while it is being operated upon. For this purpose provision is made of spring supporting hooks 52. The hooks are carried by sleeves 53 which are jointly mounted upon rods 54 and adapted to be fixed in adjusted position by means of set screws 55. The rods 54 are loosely, pivotally mounted upon the shanks of threaded members 56 carried on opposite sides of the housing I. The rods are capable of limited universal adjustment relative to the housing "I. A notched cross bar 57 is supported by the uprights I and the free ends of the rods 54 are adapted to be set in a variety of positions simply by shifting them from one notch to another of the cross bar 51.

In using the operating frame of the present invention in the reduction and manipulation of skeletal injuries such as fractures or dislocations of the lower extremities, the patient is placed in position for the operation by rolling the stretcher cart on which he lies directly under the operating frame. The sacral rest is then lowered by manipulation of the hand wheel l9 and moved longitudinally of the frame by manipulation of the hand wheel 25 until it is in proper position to support the patient at his hips. Depending upon the character of the fracture or dislocation one or both feet of the patient are secured in the stirrups 26. The patient is thus supported in the frame of this invention both at his hips and feet. It will be noted that the supporting of the patient in the operating frame has been ac complished without the necessity of lifting the patient from the stretcher onto the operating table as is now common practice. The stretcher cart may now be removed from under the lower extremities of the patient and the patient may rest his head and shoulders on the stretcher cart.

The lower extremities of the patient are thus rendered accessible for X-ray apparatus or fluoroscopic examination of the injured parts. Exact mechanical traction may be applied to displaced or overriding fractures by proper manipulation of the stirrups 26. The lower extremities of the patient are fully accessible for the application of plaster casings, molded plaster splints, or plaster casts, for the retention of the reduced deformity. After the operation is completed the stretcher cart is again placed in position to support the full length of the patient, the stirrups are removed from his feet, and the sacral rest is removed from under his thighs by manipulation of hand wheels l9 and 25. A lifting of the patient from an operating table to the stretcher is thus made unnecessary.

While the above description of the use of the frame of this invention has particular reference to the reduction and manipulation of fractures and dislocations of the lower extremities, it will be obvious to anyone skilled in the art that the frame may be used in very similar manner for fractures or disolcations of the upper extremities, the stirrups in such instances being used for holding the patients hands, and the sacral rests l6 being used to support the patients shoulders.

I have described what I believe to be the best N I do not, howembodiments of my invention. ever, wish to be confined to the embodiments shown, but what I desire to cover by Letters Patent is set forth in the appended claims.

I claim:

1. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in desired position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a portion extending over said sacral rest; and means for supporting said sacral rest from said portion, said means comprising a perineal bar extending upwardly from said rest and carried by said portion.

2. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means Comprising a frame, means for supporting said members on said frame, said frame comprising a portion extending over said sacral rest, and a perineal bar extending upwardly from said rest and carried by said portion for supporting said sacral rest from said portion.

3. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported from said carriage for supporting said rest from said carriage.

4. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported from the carriage for supporting said rest from said carriage and means for adjusting the distance of said rest from said carriage.

5. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported from the carriage for supporting said sacral rest from said carriage and means for propelling the carriage along said track.

6. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in desired position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a portion, extending over said sacral rest, and means for supporting said sacral rest from said portion, said means comprising a perineal bar extending upwardly from said rest and supported from said portion and means for propelling said extremity supporting members with reference to said rest.

7. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a portion extending over said sacral rest, a perineal bar extending upwardly from said rest and supported from said portion for supporting said sacral rest from said portion, means for adjusting the distance of said rest from said portion, and means for propelling said extremity supporting members with reference to said rest.

8. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track, a perineal bar extending vertically from said rest and supported by said carriage for supporting said rest from said carriage, means for propelling the carriage on said track, and means for propelling said extremity supporting members with reference to said rest.

9. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported by said carriage for supporting said rest from said carriage means for adjusting the distance of said rest from said carriage, and means for propelling said extremity supporting members with reference to said rest.

10. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported .by said carriage for supporting said sacral rest from said carriage means for propelling the carriage along said track and means for propelling said extremity supporting members with reference to said rest.

11.111 combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track and a perineal bar extending vertically from said rest and supported by said carriage for supporting said rest from said carriage, means for propelling the carriage along said track means for adjusting the distance of said rest from said carriage and means for propelling said extremity supporting members with reference to said rest.

12. In combination, a sacral rest, extremity supporting members and means whereby said rest and members are supported in adjustable position with reference to each other, said means comprising a frame, means for supporting said members on said frame, said frame comprising a track extending over said sacral rest, a carriage on said track, guide members for holding said carriage on said track, a perineal bar extending vertically from said rest and supported by said carriage for supporting said rest from said carriage, guide members for restraining said perineal bar to movements in the direction of its length with reference to said carriage, means for propelling the carriage along said track, means for adjusting the distance of said rest from said carriage and means for propelling the extremity supporting members with reference to said rest.

HERBERT M. BERGAMINI. 

